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Live In Remote Care Manager Jobs in Michigan (NOW HIRING)

Promoted2

Remote Insurance Agent

Kalamazoo, MI · Remote

$60K - $110K/yr

Manage client pipeline using our CRM system * Follow up to ensure satisfaction and policy retention ... Prior experience in sales, customer service, or financial services * Background in remote or ...

Promoted2

Remote Insurance Agent

Flint, MI · Remote

$60K - $110K/yr

Manage client pipeline using our CRM system * Follow up to ensure satisfaction and policy retention ... Prior experience in sales, customer service, or financial services * Background in remote or ...

Promoted2

Remote Insurance Agent

Detroit, MI · Remote

$60K - $110K/yr

Manage client pipeline using our CRM system * Follow up to ensure satisfaction and policy retention ... Prior experience in sales, customer service, or financial services * Background in remote or ...

Promoted2

Remote Insurance Agent

Grand Rapids, MI · Remote

$60K - $110K/yr

Manage client pipeline using our CRM system * Follow up to ensure satisfaction and policy retention ... Prior experience in sales, customer service, or financial services * Background in remote or ...

Promoted2

Remote Insurance Agent

Saginaw, MI · Remote

$60K - $110K/yr

Manage client pipeline using our CRM system * Follow up to ensure satisfaction and policy retention ... Prior experience in sales, customer service, or financial services * Background in remote or ...

Belle, LLC

Nurse Practitioner: Remote Urgent Care

Detroit, MI · Remote

$109K - $151K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Belle trains and manages a network of nail technicians or "Belle Technicians" who provide in-home ... As these issues arise, a team of remote nurses coordinate care with other healthcare providers ...

Kla

Full-Stack Software Engineer - Remote Services

Ann Arbor, MI · Remote

$105K - $180K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... proactive management of tools to identify and improve performance; expertise in optics, image ... care and bonding leave. Interns are eligible for some of the benefits listed. Our pay ranges are ...

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Auditor, Healthcare Services (Remote in MI)

Molina Healthcare

Detroit, MI • On-site, Remote

$26.41 - $51.49/hr

Full-time

Posted 27 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

165th of 309 rated insurance

Job description


JOB DESCRIPTION
This position will offer remote work flexibility, but the selected candidate must reside in Michigan.
Opportunity for an RN who has a US license in good standing to join our Medicaid Team as a Clinical Auditor. The person filling this role will be an instrumental part of the team work to align the Medicaid Team compliance guidelines with those followed by our corporate teams. Knowledge and experience working with Waiver Program is vital to success in this role.
The preferred candidate will have 3 - 5 years of experience in a MCO and at least 2 years of clinical auditing and/or review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill sets we are seeking. Licensure should be an LPC, RN, LLMSW, LMSW, LBSW.
Hours are Monday - Friday, 8:30AM - 5PM EST.
Job Summary
Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed.
• Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met.
• Assesses clinical staff regarding appropriate clinical decision-making.
• Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
• Ensures auditing approaches follow a Molina standard in approach and tool use.
• Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications.
• Adheres to departmental standards, policies and protocols.
• Maintains detailed records of auditing results.
• Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results.
• Meets minimum production standards related to clinical auditing.
• May conduct staff trainings as needed. • Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
• At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Strong attention to detail and organizational skills.
• Strong analytical and problem-solving skills.
• Ability to work in a cross-functional, professional environment.
• Ability to work on a team and independently.• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
• Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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